The nurse is inspecting the genitals of a prepubescent girl. Which is a normal sign of the onset of puberty?

A. Pulse rate is increased.

While there may be variations in pulse rate due to factors such as activity level and emotional state, a significant increase in pulse rate would not be a typical finding during an annual check- up for an 8-year-old child.

B. Breathing is diaphragmatic.

As children grow older, their respiratory patterns mature, and they develop diaphragmatic breathing, which is deeper and more efficient than the shallow breathing observed in infants. This change would be expected as the child gets older.

C. Secondary sex characteristics are present.

The development of secondary sex characteristics typically occurs during puberty, which begins around the ages of 9 to 13 in girls and 10 to 14 in boys. At 8 years old, it would be unlikely for significant secondary sex characteristics to be present.

D. Blood pressure has reached adult level.

Blood pressure in children gradually increases with age, but it does not reach adult levels until adolescence. At 8 years old, the child's blood pressure would still be within the pediatric range and would not resemble adult levels.

A. "It is best to just ignore this and to not respond to his questions.": Ignoring the child's questions about the death of his grandfather may lead to feelings of confusion or abandonment. It is important to address the child's concerns and provide appropriate support and guidance.

B. "He will eventually figure this out on his own.": While children may gradually come to understand the permanence of death as they mature, it is essential to provide support and explanations to help them cope with grief and loss.

C. "You have to keep repeating that his grandfather is never coming back.": Continually

repeating that the grandfather is never coming back may be distressing for the child and does not provide constructive support or help the child understand the concept of death.

D. "This is normal; children his age do not understand the permanence of death.": This response acknowledges the child's age-appropriate understanding of death and provides reassurance to the mother that her son's reaction is typical. It opens the door for the nurse to offer guidance on how to support the child through the grieving process and gradually help him comprehend the permanence of death.